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General NPI Number Information
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NPI Number | 1558451112
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Entity Type | Individual
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Provider Name | SUSAN RAMOS TAN MD
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 705 E VIRGINIA WAY STE I
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City | BARSTOW
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State | CA
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Zip | 92311-3955
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Country | US
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Telephone | 760-255-3900
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Fax | 760-255-3980
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Provider Business Mailing Address
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Address Line | PO BOX 626
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City | BARSTOW
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State | CA
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Zip | 92312-0626
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Country | US
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Telephone | 760-255-3900
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Fax | 760-255-3980
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A68769
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A68769
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License Number State | CA
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